Measure Information Form

Description: Heart failure patients discharged home with written instructions or educational material given to patient or caregiver at discharge or during the hospital stay addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen.

Rationale: Patient non-compliance with diet and medications is an important reason for changes in clinical status. Health care professionals should ensure that patients and their families understand their dietary restrictions, activity recommendations, prescribed medication regimen, and the signs and symptoms of worsening heart failure. National guidelines strongly support the role of patient education (Hunt, 2005). Despite this recommendation, comprehensive discharge instructions are rarely provided to eligible older patients hospitalized with heart failure (CMS National Heart Failure Project baseline data).

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Heart failure patients with documentation that they or their caregivers were given written discharge instructions or other educational material addressing all of the following:

An ICD-9-CM Principal Diagnosis Code for heart failure as defined in Appendix A, Table 2.1 AND

A discharge to home or home care

Excluded Populations:

Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during hospital stay (ICD-9-CM procedure code for LVAD and heart transplant as defined in Appendix A, Table 2.2)

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: The data elements for each of the six discharge instruction elements provide the opportunity to assess each component individually. However, completion of all six instruction categories is required for this composite measure.

Hunt SA. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005; 46(6):e1-82.